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General NPI Number Information
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NPI Number | 1972629236
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Entity Type | Organization
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Legal Business Name | SOUTHPOINTE CHIROPRACTIC AND FITNESS
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Dates
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Enumeration Date | 03/21/2007
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Last Update Date | 02/12/2009
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Provider Practice Location Address
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Address Line | 673 MORGANZA RD STE 105
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City | CANONSBURG
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State | PA
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Zip | 15317-5715
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Country | US
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Telephone | 724-873-0700
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Fax |
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Provider Business Mailing Address
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Address Line | 673 MORGANZA RD STE 105
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City | CANONSBURG
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State | PA
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Zip | 15317-5715
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Country | US
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Telephone | 724-873-0700
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | TYSON THOMAS SWIGART
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Credential | DC
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Telephone | 724-873-0700
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111NS0005X
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Taxonomy Name | Sports Physician Chiropractor
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License Number | DC007385L
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License Number State | PA
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